| ObjectiveTotal hysterectomy is a common surgical method for the treatment of nonpregnant women with cervical lesions(cervical intraepithelial neoplasia)and benign diseases such as abnormal uterine bleeding and uterine leiomyoma.However,in recent years,clinical studies have shown that in laparoscopic total hysterectomy,the main ligament and sacral ligament of the uterus are cut off,and the suspension supporting structure at the top of the vagina disappears,which can affect the autonomic nerves innervating the bladder and rectum,reduce the blood supply of pelvic organs and induce pelvic floor dysfunction(Pelvic floor dysfunction,PFD).In addition,the operation changed the vaginal supporting structure,which could cause different degrees of vaginal prolapse and vaginal wall prolapse,destroy the vaginal rectal septum and vesicovaginal septum,increase the activity of detrusor,and cause stress urinary incontinence(Stress urinary incontinence,SUI).If there is no timely intervention and treatment,it may have a serious impact on the function of pelvic floor muscle and quality of life of the patients after operation.In this study,single pelvic floor muscle functional exercise(pelvic floor muscle training,PFMT)and biofeedback electrical stimulation combined with pelvic floor muscle exercise were applied to patients after laparoscopic total hysterectomy,and their effects were observed to explore the effects of single pelvic floor muscle exercise and biofeedback electrical stimulation on pelvic floor muscle function and quality of life of patients after laparoscopic total hysterectomy.To provide scientific basis for improving postoperative pelvic floor muscle function,preventing pelvic organ prolapse(Pelvic organ prolapsed,POP)and different types of urinary incontinence,and improving postoperative life happiness index of patients.MethodsSixty patients who underwent laparoscopic total hysterectomy for non-prolapsed uterine benign lesions in the second affiliated Hospital of Anhui Medical University from January 2017 to December 2018 were randomly divided into experimental group(n = 30)and control group(n = 30).The control group was treated with a single pelvic floor muscle exercise(PFMT)therapy,while the experimental group was treated with biofeedback electrical stimulation therapy.The pelvic floor function and quality of life of the two groups were evaluated for the first time 3 months after operation.The perineal muscle strength test and the main pelvic floor EMG parameters were used to evaluate the pelvic floor function of the two groups at 3 months,6 months and 12 months after operation.the symptoms of lower urinary tract and intestinal tract in different treatment periods were observed and compared.Pelvic floor function impact questionnaire(Pelvic floor impact questionnaire-7,PFIQ-7)and pelvic organ prolapse /urinary incontinence sexual function questionnaire(Pelvic organ prolapse/Urinary incontinence sexual questionnaire-12,PISQ-12)were used to evaluate the life happiness index of the two groups from different aspects and different dimensions.Results1)General data of the subjects: the average age of 30 patients in the test group was52.33±0.75 years old,the average body mass index was 24.21±0.21,the average number of pregnancies was 3.60±0.13,the average average parturition was 1.60±0.09,the average number of cesarean sections was 0.60±0.10,and the average length of education was 4.33±0.39.The average age of 30 patients in the control group was51.77±0.76 years old,the average body mass index was 24.81±0.32,the average number of pregnancies was 3.70±0.15,the average average parturition was 1.50±0.13,the average number of cesarean section was 0.67±0.11,and the average years of education was 4.17±0.34.There was no significant difference in general data between the two groups.2)grading of pelvic floor muscle strength: 60 patients with pelvic floor muscle strength ≤ grade 3 3 months after operation,the number of patients with grade 4 or more 6 months and 12 months after operation(20 cases of type Ⅰ muscle,19 cases of class Ⅱ muscle,25 cases of class Ⅰ muscle and 26 cases of class Ⅱ muscle)was increasing,which was statistically significant.In the control group,the number of patients with muscle strength ≥ 4 grade 6 months and 12 months after operation(12cases of type Ⅰ muscle,12 cases of type Ⅱ muscle,19 cases of type Ⅰ muscle and 20 cases of type Ⅱ muscle)was significantly higher than that in the control group.the number of cases of muscle strength improvement increased significantly,and the comparison was statistically significant.3)the EMG parameters of pelvic floor: compared with 3 months after operation,the EMG values of type Ⅰ and Ⅱ muscle fibers in 60 patients were significantly increased at 6 months and 12 months after operation.the surface electric value of pelvic floor muscle measured in this study was significant in time and interaction between groups(P < 0.05).4)Lower urinary tract and intestinal symptoms: 60 patients had different lower urinary tract and intestinal symptoms 3 months after operation,and the number of patients with lower urinary tract and intestinal symptoms decreased gradually at 6months and 12 months after operation.among them,the number of cases of stress urinary incontinence decreased significantly,and the experimental group(18 cases at 3months,5 cases at 6 months,2 cases at 12 months after operation)was higher than that in the control group(20 cases at 3 months,13 cases at 6 months after operation).The improvement was obvious in 8 cases 12 months after operation,and the improvement of such symptoms in the test group was more obvious than that in the control group,which was statistically significant.5)PFIQ-7 questionnaire and PISQ-12 questionnaire: the PFIQ-7 and PISQ-12 questionnaires of the two groups at 6 months and 12 months after operation showed that compared with 3 months after operation,60 patients were affected by pelvic floor diseases,and the life happiness index of patients in the experimental group increased significantly,and this relationship was statistically significant.ConclusionThe pelvic floor function and quality of life of the two groups were improved at different time after treatment,and the pelvic floor function index and quality of life score of the patients in the test group were significantly better than those in the control group.Reasonable pelvic floor rehabilitation after laparoscopic total hysterectomy can effectively prevent and improve pelvic floor muscle function and enhance their wellbeing.Biofeedback electrical stimulation combined with PFMT is more effective,which is worthy of clinical promotion. |
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